Hormonal Cycles in Women: Effects on TMD Pain & Symptoms

描述（由申请人提供）：疼痛被定义为“与实际或潜在的组织损伤相关的不愉快的感觉和情绪体验”。因此，疼痛不可避免地是身心相互作用的产物。我们建议研究与颞下颌疾病（TMD）相关的身心相互作用，TMD是一组涉及咀嚼肌肉和颞下颌关节的疼痛状况。在社区中，这些疼痛问题在女性中的发生率大约是男性的两倍，患病率在生育年龄达到高峰。TMD疼痛的病因尚不清楚，但心理压力、抑郁和其他躯体疾病的存在已被证明会影响这些疾病的病程。先前的研究表明，女性生殖激素也可能影响TMD疼痛。具体来说，正常月经周期的TMD女性在月经前雌激素急剧下降时，TMD疼痛水平会上升，而在月经期间，TMD疼痛达到峰值。有趣的是，TMD疼痛的第二个高峰发生在排卵期，这是另一个与雌激素快速变化相对应的阶段。这些数据表明TMD疼痛水平与月经周期阶段之间存在系统关系。我们提出两项相关研究来进一步研究女性TMD疼痛的周期性。研究1将评估月经周期正常的女性TMD患者在连续两个月经周期中疼痛与唾液生殖激素水平和心理压力的关系（n = 35），以及相同规模的适当对照组-正常月经周期的发作性头痛女性和正常月经周期的对照组女性，没有TMD，头痛或其他慢性疼痛问题。研究1旨在验证临床疼痛和月经周期症状的增加与雌激素戒断和感知压力增加有关的假设。研究2将操纵行为和激素因素，假设影响TMD疼痛，比较效果：1)旨在抑制月经和稳定激素环境的持续口服避孕药干预，2)专注于TMD症状在月经周期中的时间生物学的自我管理干预，以及3)通常的自我管理干预，不定时生物事件。本临床试验的目的是阐明女性TMD疼痛和症状周期性的机制，并确定哪种治疗方式能最大程度地改善TMD疼痛和症状。因此，拟议的研究将为妇女疼痛感知的生物学和社会心理方面的关系提供重要和独特的信息。

DESCRIPTION (provided by applicant): Pain is defined as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage." Thus, pain is, inevitably, a product of the interaction of mind and body. We propose to study the interactions of mind and body related to temporomandibular disorders (TMD), a group of painful conditions involving the muscles of mastication and the temporomandibular joint. These pain problems are about twice as common in women as in men in the community, and prevalence peaks during the reproductive years. The etiology of TMD pain is unknown, but psychological stress, depression and the presence of other somatic complaints have been shown to influence the course of these disorders. Prior research suggests that female reproductive hormones may also influence TMD pain. Specifically, normally cycling women with TMD experience rising levels of TMD pain pre-menstrually during a time of precipitous drop in estrogen and show peak TMD pain during menses. Interestingly, a secondary peak of TMD pain occurs at about the time of ovulation, another phase corresponding to rapid estrogen change. These data demonstrate a systematic relationship between levels of TMD pain and phases of the menstrual cycle. We propose two related studies to further investigate the cyclic nature of TMD pain in women. Study 1 will assess the relationship of pain to salivary levels of reproductive hormones and to psychological stress across two consecutive menstrual cycles for female TMD patients with normal menstrual cycles (n = 35), as well as appropriate comparison groups of the same size --normally cycling women with episodic headache and normally cycling control women without TMD, headache or other chronic pain problems. Study 1 is designed to test the hypothesis that increases in clinical pain and symptoms across the menstrual cycle are associated with estrogen withdrawal and increased perceived stress. Study 2 will manipulate the behavioral and hormonal factors that are hypothesized to influence TMD pain, comparing the effects of: 1) a continuous oral contraceptive intervention designed to suppress menses and stabilize the hormonal environment, 2) a self-management intervention focused on and timed to the chronobiology of TMD symptoms across the menstrual cycle, and 3) a usual self-management intervention not timed to biological events. The aims of this clinical trial are to shed light on the mechanisms underlying the cyclic nature of TMD pain and symptoms in women, as well as to determine which treatment modality results in the greatest improvement in TMD pain and symptoms. Thus, the proposed studies will provide important and unique information on the relationships of biological and psychosocial aspects of pain perception in women.